Represent Us Form

Please complete the form below to request more information about representing American General Life Companies.

Please be advised that claim inquiries or other time-sensitive inquiries/requests should not be sent to American General via this email. Please contact your local broker or American General Life Companies Customer Service for these types of inquiries.

Asterisk (*) indicates required fields

First Name:

Address:

Middle Name:

City:

Last Name:

State / Zip:

Company Name:

Phone:

Contact by:

Email:

How many years of experience do you have?

Which products are you interested in selling? *

Life
Annuity
Accident and Health
Long Term Care

What are your annualized premium sales for the previous 12 months?

Life
Annuity
Accident and Health
Long Term Care

Are you currently a

Personal Producer
Marketing Organization

	If Yes then
		How many agents are in your hierarchy?
		How many states are you operating in?

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